Combination therapy does not improve ability to quit smoking after 1 year

Among cigarette smokers, the combined use of the smoking cessation medications varenicline and bupropion, compared with varenicline alone, resulted in better rates of smoking abstinence at 12 weeks, but rates were similar after one year, according to a study in the January 8 issue of JAMA.

Smoking accounts for 62 percent of deaths among female smokers and 60 percent of deaths among male smokers. Innovative pharmacotherapeutic approaches to tobacco-dependence treatment need investigation to reduce smoking-related death and disability, according to background information in the article. "Exploration of combination therapy with existing drugs may provide the best opportunity to advance treatment in the absence of any new pharmacotherapies for tobacco dependence."

Jon O. Ebbert, M.D., M.Sc., of the Mayo Clinic, Rochester, Minn., and colleagues investigated the efficacy of combination pharmacotherapy with varenicline and bupropion SR (sustained-release) for smoking cessation, compared with varenicline alone (monotherapy). The trial included 315 adults who completed the study. Participants were randomized to 12 weeks of varenicline and bupropion SR or varenicline and placebo. There was follow-up through week 52.

"Among cigarette smokers, combined use of varenicline and bupropion, compared with varenicline alone, resulted in an increase in prolonged abstinence but not 7-day point-prevalence at 12 and 26 weeks; neither outcome was significantly different at 52 weeks. Further research is required to determine the role of combination treatment in smoking cessation," the authors conclude.

Editor's Note: The clinical trial was supported by a National Institutes of Health grant (primary investigator, Dr. Ebbert). Medication (varenicline) was provided by Pfizer. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

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